BACKGROUND AND OBJECTIVE

Orthodontic brackets predispose dental biofilm accumulation causing caries and gingivitis. Chlorhexidine is an adjunct to mechanical plaque removal, but has side-effects (tooth staining, bacterial resistance) due to long term use. This study tested the efficacy of Photodynamic Therapy, which produces reactive oxygen species, to reduce Streptococcus mutans in dental biofilm on orthodontic brackets.

A 5-day S. mutans biofilm was grown on forty enamel-bracket specimens. Thirty-nine specimens were randomized to three treatment groups: A. Distilled Water; B. 0.12% Chlorhexidine (CHX); C. Photodynamic Therapy (PDT) using Toluidine Blue O (TBO) as a photosensitizer, activated by red LED (630nm). After treatment, one random specimen from each group was viewed under Environmental Scanning Electron Microscopy (ESEM); the other 12 specimens, biofilms were collected, weighed, and cultured onto BHI agar plates to determine the number of CFU/mg. For baseline evaluation, one clean and one untreated specimens were preserved for ESEM.

Based on Tukey HSD test, group A had the most S. mutans (37.0573 CFU/mg) and was significantly different (pCONCLUSION

Both Photodynamic Therapy and 0.12% Chlorhexidine showed a significant reduction of S. mutans in dental biofilm on orthodontic brackets. However, there is no significant difference between them in reducing S. mutans CFU/mg. Photodynamic therapy could be an alternative adjunctive tool to mechanical removal of plaque adhered to orthodontic brackets.

Incontinentia Pigmenti (IP) is an X-linked dominant genodermatosis caused by a mutation of the NEMO or IKBKG gene. Cutaneous manifestations are common, however, involvement of the eyes, teeth, and central nervous system can also be seen. Genetic counseling plays a vital part in the management, as well as a multidisciplinary approach involving other specialties.

This is a case of a newborn female with unremarkable birth and maternal history who presented with erythematous papules, vesicles, and pustules on the trunk, upper extremities, and lower extremities upon birth. She was born term via normal spontaneous delivery to a 34-year-old G1P0 with no known personal and family history of dermatologic or other genetic conditions. On the 5th day of life, lesions started to form a whorl-like appearance, eventually turning hyperpigmented, with a blaschkoid distribution. Skin punch biopsy revealed several eosinophils on the dermis highly suggestive of IP. Dermoscopy showed polycyclic scaling with a yellowish center and erythematous halo. Genetic testing revealed a heterozygous pathogenic deletion encompassing exons 4-10 of the IKBKG gene, confirming the diagnosis of IP. Genetic counseling was done. The patient’s family was advised periodic monitoring and surveillance.

Dermoscopy in IP can provide an earlier diagnosis. Stage I shows a yellowish center and erythematous halo with yellowish serocrusts surrounded by polycyclic scaling. Only two cases of IP dermoscopy have been published so far. Dermoscopy complements histopathology in IP.

Leprosy presents diversely, making diagnosis challenging. Histoid leprosy is a rare variant with atypical features. We present a case of a 40-year-old Filipino male with multiple erythematous to flesh colored, well demarcated hypoesthetic nodules primarily on his back and abdomen. Dermoscopy revealed features of granulomatous disease. Fite-Faraco stain showed globi formation. Skin biopsy showed epidermal atrophy, dense histiocyte infiltrates and collagen trapping. While histoid leprosy is uncommon in patients without a prior history of leprosy and treatment, this case highlights the importance of maintaining a high index of suspicion, especially in endemic regions. Early diagnosis and prompt multidrug therapy are crucial for preventing transmission and improving patient outcomes.

Pyoderma gangrenosum causes the destruction of skin tissue and then ulceration. There are currently no international treatment guidelines. Abrocitinib, a JAK1 selective inhibitor, has been used as treatment in some case reports.

A 54-year-old female, diagnosed for 20 years with ulcerative colitis and mostly treated with Chinese herbal medicine, admitted for a solitary painful ulcer on the right lateral ankle, measuring 10x8 cm, with swelling of the right lower leg. Antibiotics were given and wound debridement, exploration, then vacuum-assisted closure dressing were done. She was then referred to dermatology service. Wound care was done by light cleansing of the wound with cold-pressed virgin coconut oil (CP-VCO) - soaked gauze, gentle removal of wound and edge scabs, application of 30% Trichloroacetic Acid on the rounded edges of the ulcer, and covered with a gauze saturated with CP-VCO dressing. Abrocitinib 200 mg/tablet was started once a day. After being discharged, abrocitinib and wound care, with an added pharmacist-compounding of 4% monolaurin, 1% monocaprin, and 10% tranexamic acid in a petrolatum base, was maintained with the same dosage and frequency. At the end of the fourth month, the ulcer completely healed into a solitary pinkish to skin-colored linear scar, measuring at 1.8x4 cm. Dermoscopy monitoring of the wound healing showed progressive lines of epithelialization advancing into the ulcer to a scar with a cribriform pattern of epithelialized red dots.

The excellent results from this pyoderma gangrenosum case report using a combination of these treatment modalities are an opportunity to consider in future clinical cases.

BACKGROUND

Accurate diagnosis of onychomycosis is important because its treatment is long-term, costly, and sometimes with complications. KOH test is quick and cheap but has low sensitivity. Hence, the need for additional tests such as culture and/or PAS. However, these two tests are not readily available and expensive. Dermoscopy is an emerging tool for the diagnosis of nail conditions.

This study aims to evaluate the accuracy of dermoscopy as a point-of-care tool in diagnosing distal subungual onychomycosis (DSO).

This is a prospective, cross-sectional study of 22 clinically diagnosed DSO patients selected via convenience sampling in a tertiary hospital from November 2019 to March 2021. Participants had gross nail examination, dermoscopy, KOH and PAS tests. Measures of diagnostic accuracy for the different dermoscopic patterns were obtained, with KOH and PAS results as reference standard.

Fifty-one nail samples were submitted for processing with only 49 nails accepted for analysis. The most common pattern was jagged edge with spikes (65.3%). Combining all 5 dermoscopic patterns increased the sensitivity to 91.2% (95% CI: 76.3, 98.1).

Dermoscopy may be used as a first-step, point-of-care tool in the diagnosis of DSO. Addition of mycological and histopathological tests is still warranted for confirmation.

BACKGROUND

Hansen’s Disease, a chronic infectious disease, presents with a variety of cutaneous lesions. Being the “great mimicker” that it is, patients may often be misdiagnosed initially, hence the delay in the initiation of the multidrug therapy. Dermoscopy offers an effective, efficient, operator-friendly and non-invasive adjunctive tool in the diagnosis of Hansen’s Disease.

The general objective of the study is to describe the common dermoscopic features according to clinical and histologic findings among all newly diagnosed Hansen’s Disease patients in a tertiary institution within the study period of 6 months.

Purposive sampling was applied to include all newly diagnosed and biopsy-proven Hansen’s Disease patients aged 18 years to 65 years. Participants were clinically examined and dermoscopy was performed on a representative lesion. Other data were collected from chart review, acid fast smear and histopathology reports.

The main dermoscopic feature of Hansen’s Disease is yellowish orange areas observed in all 23 cases studied regardless of the spectrum. This feature can be attributed well to the presence of granuloma formation and inflammation. Another common feature is the presence of white globules and dots which correlates to the presence of the grenz zone, while vascular structures correlate with dilated blood vessels on histopathology.

The major dermoscopic features seen in the study may add to the clinical clues to arrive at a diagnosis of Hansen’s Disease. Although dermoscopy alone is insufficient for the confirmation of Hansen’s Disease, combining it with physical findings would provide additional basis for its clinical diagnosis.

Background: Dermoscopy enhances detection of basal cell carcinoma (BCC), especially for the pigmented subtype common among Asians. However, there is limited data on dermoscopic features of BCC in Filipinos. Objectives: The objective of this study is to describe the clinicopathologic profile and dermoscopic features of BCC in Filipinos seen in a tertiary care clinic. Methods: A cross-sectional study was conducted in the Philippines from November 2019 to December 2021 in a tertiary care clinic. Fifty-three (53) lesions suspicious for BCC were analyzed using dermoscopy prior to histologic confirmation. Fifty (50) biopsy-proven BCC lesions were included in the analysis. Results: Lesions were more commonly seen in females (72.50%), and located on the head and neck (88%). The most common histopathologic subtype was nodular (74%). The most common dermoscopic features were large blue-gray ovoid nests (86%) and ulcerations (70%). Conclusion The most common BCC type among the study participants was nodular, with large blue-gray ovoid nests and ulceration seen on dermoscopy.
carcinoma, basal cell ; dermoscopy

OBJECTIVES: This study aimed to compare the effectiveness of ultrasound and acoustic and laser cleaning of curved root canals. METHODS: A total of 92 molars with independent root canals with a curvature of 20°-40° were prepared and standardized at 04 25# and stained with gentian violet solution for 72 h. Among them, 52 were randomly divi-ded into four groups for final rinsing (n=13): NI group, PUI group, EDDY group, and PIPS group. Ten samples in each group were cut horizontally along the long axis perpendicular to the root and divided into curved upper, curved, and apical segments. Images were taken with a stereomicroscope and Image J measurements were taken to calculate the depth of rinse penetration. The remaining three samples from each group were split along the long axis of the dentin, photographed by scanning electron microscope to record the dentin tubule exposure and staining layer, and scored for staining layer by double-blind method. SPSS 26.0 software was used to perform statistical analysis and select the best flushing method. An extra 40 samples were randomly divided into four groups for detection of flushing fluid penetration depth (n=10): 10, 20, 30, and 40 s. RESULTS: In the upper part, the mean depth of infiltration was not significantly different between the experimental and control groups (P>0.05). The PIPS group had a significantly lower smear layer score than the control group and the EDDY group (P<0.01). In the curved segment, the mean depth of infiltration was significantly greater in the PUI group than in the control group (P<0.05); the tarnish layer score was lower in each experimental group than in the control group. At the top, the mean depth of infiltration was greater in the PUI and PIPS groups than in the control group (P<0.05), and the smear layer score was lower in the PIPS group than in the other groups (P<0.05). After the time was changed, the depth of infiltration of PUI increased only in the apical segment as the flushing time increased. CONCLUSIONS The PUI and PIPS methods facilitate the penetration of irrigation solution into the dentin canal in curved root canals, especially in the apical segment. The PIPS technique is effective in removing the smear layer in curved root canals.
Humans ; Dental Pulp Cavity ; Microscopy, Electron, Scanning ; Root Canal Irrigants ; Root Canal Preparation/methods* ; Smear Layer ; Sodium Hypochlorite ; Therapeutic Irrigation/methods* ; Double-Blind Method

Objective To assess the effects of different application sequences of neodymium-doped yttrium aluminum garnet(Nd∶YAG)laser and the desensitizing toothpaste containing stannous fluoride on dentinal tubule occlusion.Methods Twelve intact third molars freshly extracted from human were selected and prepared into dentin slices with a thickness of 0.8 mm.Each dentin slice was subdivided into four small slices,three of which were etched with 6% citric acid and randomly assigned to the following three groups(n=12):(1)control group:no treatment;(2)Nd∶YAG+toothbrushing(TB)group:first irradiated with Nd∶YAG laser and then brushed with desensitizing toothpaste;(3)TB+Nd∶YAG group:first brushed with desensitizing toothpaste and then irradiated with Nd∶YAG laser.The Nd∶YAG laser irradiation were carried out at 1 W,15 pulses/s,and the pulse width of 150 μs for 10 s(for a total of 6 cycles).After the above treatment,the 12 dentin slices from the Nd∶YAG+TB and TB+Nd∶YAG groups were randomly assigned to four subgroups(n=3)and subjected to acid etching in the Coca-Cola solution for 0,5,10,and 15 min.A scanning electron microscope was used to observe and photograph the dentin slices in each group,and eight single-blinded examiners scored the slices according to uniform criteria.The analysis of variance was carried out to compared the scores between groups.Results Before acid etching,the dentin tubule occlusion scores of the Nd∶YAG+TB and TB+Nd∶YAG groups were(4.83±0.09) scores and(3.85±0.66) scores,respectively,which had no significant difference between each other(P=0.0590)and were higher than that[(0.10±0.07)scores]of the control group(both P<0.0001).The dentin tubule occlusion scores of the Nd∶YAG+TB group after acid etching for 5,10,and 15 min were(4.33±0.60)scores,(4.27±0.24)scores,and(3.63±0.07)scores,respectively,which were not significantly different from those[(4.04±0.10)scores,(3.76±0.59)scores,and(3.17±0.29)scores,respectively]of the TB+Nd∶YAG group(all P>0.05).In the Nd∶YAG+TB subgroup,the dentin tubule occlusion score after acid etching for 15 min was significantly lower than that before acid etching(P=0.0011).In the TB+Nd∶YAG group,there was no statistically significant difference in the score between before and after acid etching(P>0.05).Conclusions Nd∶YAG laser irradiation with appropriate parameters combined with the use of desensitizing toothpaste could produce an excellent occluding effect on dentinal tubules regardless of the sequence.However,brushing with desensitizing toothpaste followed by Nd∶YAG laser irradiation produced more consistent dentin sealing after acid etching.
Humans ; Dentin ; Dentin Sensitivity/therapy* ; Lasers, Solid-State/therapeutic use* ; Microscopy, Electron, Scanning ; Toothpastes/pharmacology*

Background: Medical education has changed as a result of the COVID-19 pandemic. There has been a shift from face to face learning to virtual classes using online learning platforms such as Canvas. These virtual and online alternative methods to medical education brought up concerns about the preparedness of medical students in studying Histology. This study addresses the student’s preference and attitude on the learning of histology using light microscopy vs virtual microscopy. Objectives: The specific objectives of the study are to determine students’ preference, attitudes, and overall satisfaction on the use of light microscopy vs virtual microscopy using a Likert scale. Methods: An enhancement program was conducted by the Department of Anatomy, UP College of Medicine from June 13 to June 17, 2022 among first year medical students. The students were exposed to prosected cadavers, models, specimens, histologic glass slides, and electronic images. During the activity, the second and third floor of Calderon Hall was divided into several stations, each with its own learning outcomes.This is a descriptive cross-sectional study. In all the learning stations, both virtual and light microscopy learning modalities were made available to the students. The student was at liberty to select virtual microscopy, light microscopy or both. In one of the stations, allocated to OS 205 (The study of the anatomy and histology of the thorax), students were randomized to one learning modality (light vs virtual microscopy) and made to identify one predetermined structure. Students answered a short questionnaire that allowed them to express their preference for the modality that was assigned. The questionnaire survey included questions on students’ preference for either light microscopy (LM) or virtual microscopy (VM), ease of use, and satisfaction. A total of five statements were included in the survey questionnaire. All questions in the survey were scored on a 5-point Likert scale (5: strongly disagree, 4: disagree, 3: neutral, 2: agree, and 1: strongly agree). A comments section was also included in the survey to explore students’ experiences of the two learning methods. Results: A total of 160 students participated in the study. Seventy-nine (79) students were randomized to the light microscopy group and 81 one students were randomized to the virtual microscopy group. There were no differences in the demographic characteristics between those randomized to virtual vs light microscopy.There were no differences in the net ratings between those randomised to virtual vs light microscopy in the following domains: 1) ease in looking for structures, 2) ability to identify the structure correctly, 3) method enhancing learning, and 4) overall satisfaction. There was a difference in the net rating between those randomized to virtual vs light microscopy in the domain on quality of the image being easily adjusted (58% vs 97.5%). Conclusion Medical students who used light microscopes demonstrated a more positive attitude towards its ability to enhance learning and showed greater satisfaction in using this method. Ease in manipulating image quality was better in the light microscopy group. However, the accuracy of identification of histological structures using either platform did not differ. Both virtual and light microscopy are effective learning methods.
Microscopy ; Education, Medical ; Histology ; Teaching